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Organization

MAPLE LAKE ACADEMY FOR BOYS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARGO L VANE (OFFICE MANAGER)
(801) 798-7700
Entity
Organization

Contact information

Practice address
6612 S 3200 W, BENJAMIN, UT 84660-4123
(801) 798-7700
Mailing address
6612 S 3200 W, BENJAMIN, UT 84660-4123
(801) 798-7700

Taxonomy

Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
18290
UT

Other

Enumeration date
02/03/2017
Last updated
02/03/2017
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